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It’s normal to experience changes in your mood before and during your period. In fact, over 90 percent of women experience some degree of premenstrual syndrome, or PMS — a syndrome that can involve feelings of sadness, irritability and reduced interest in certain parts of life.
For some women, the feelings of anxiety, depression and irritability that can occur before and during menstruation are much more severe.
Premenstrual dysphoric disorder, or PMDD, is a medical condition that’s similar to PMS but far more serious. It affects up to five percent of women of childbearing age and can cause severe, debilitating symptoms that affect you before and during your period.
Dealing with PMDD can be difficult, but the good news is that it’s usually treatable with a mix of medication, therapy and lifestyle changes.
Below, we’ve explained what premenstrual dysphoric disorder is, as well as the symptoms you may experience if you’re affected. We’ve also talked about the best options for treating PMDD and improving your quality of life before and during your period.
Premenstrual dysphoric disorder is a health problem that involves severe symptoms that occur before and during your period. It’s similar to premenstrual syndrome (PMS), but often involves mood disorder symptoms that are far more serious and debilitating.
PMDD usually starts in the luteal phase of your menstrual cycle. Because it occurs before and during your period and produces symptoms similar to major depression, it’s often referred to as premenstrual depression. It might be different from anxiety before period.
Premenstrual dysphoric disorder can cause physical and emotional symptoms, including some that may have a serious impact on your well-being.
Common symptoms of premenstrual dysphoric disorder include:
Irritability and/or anger that affects the people around you
Feelings of sadness, hopelessness and despair
Severe mood swings, including frequent crying
Difficulty staying focused on specific tasks
Sleep issues, such as difficulty falling asleep
Feelings of anxiety and/or panic attacks
Loss of interest in daily activities
Reduced interest in relationships and social activities
Fatigue and a general lack of energy
Food cravings and/or binge eating
Increased sensitivity to rejection
A feeling of being out of control
Suicidal thoughts or behavior
Cramps, headaches, muscle pain and joint pain
Fluid retention, bloating and breast tenderness
Many symptoms of premenstrual dysphoric disorder are similar to the signs of major depressive disorder in women.
If you’re affected by PMDD, you’ll usually experience symptoms five to 11 days prior to the start of your menstrual cycle. It’s common for symptoms to either stop or become less severe within a few days of menstrual bleeding.
Although PMDD usually only causes symptoms before and during your menstrual period, it can be a chronic condition that has a significant impact on your daily life and personal health.
Most women have approximately 459 menstrual cycles during childbearing age. At an average of 6.4 days of severe symptoms with each menstrual cycle, PMDD can cause the equivalent of eight years of debilitating symptoms throughout your life.
Experts aren’t yet aware of precisely what causes premenstrual dysphoric disorder. The current research suggests that a variety of risk factors may be involved, including:
Hormonal fluctuation caused by your menstrual cycle
Disorders that affect your thyroid hormone levels
Being exposed to traumatic events in the past
Sudden fluctuations in serotonin levels
Having a family history of premenstrual dysphoric disorder
Living a sedentary (low activity) lifestyle
Being overweight or obese
Premenstrual dysphoric disorder is common in women who have other mental disorders, such as anxiety disorders, severe depression or seasonal affective disorder. However, it isn’t clear that these conditions directly cause premenstrual dysphoric disorder.
Experts aren’t yet aware of precisely what causes premenstrual dysphoric disorder. However, it may be linked to the fluctuations in certain hormone levels that occur throughout your menstrual cycle.
There’s some scientific evidence to suggest that premenstrual dysphoric disorder has a genetic component. You have an elevated risk of developing PMDD if your mother also suffers from this condition, and an even higher risk if you have an identical twin with PMDD.
Other risk factors for PMDD include:
Suffering from a mental illness or mood disorder, such as anxiety, seasonal affective disorder (SAD) or another depressive disorder
Having a thyroid health issue, such as high or low thyroid hormone levels
Having an alcohol or substance use disorder
Being overweight or maintaining a sedentary lifestyle
If you often experience a depressed mood, irritability, lack of interest in your usual activities and other PMDD symptoms before and during your period, it’s important to talk to your primary care provider about how you feel.
To diagnose PMDD, your healthcare provider may ask you about your symptoms. You’ll usually need to have at least five recognizable symptoms, including one mood-related symptom, to be diagnosed with PMDD.
As part of this process, your healthcare provider may ask you about other psychiatric disorders that can cause similar symptoms to PMDD, such as bipolar disorder or panic disorder.
PMDD is treatable. If you’re diagnosed with premenstrual dysphoric disorder, your healthcare provider may recommend one or several of the effective treatment options below.
Several types of medication are used to treat premenstrual dysphoric disorder, including drugs called selective serotonin reuptake inhibitors (SSRIs).
SSRIs are a class of antidepressants. They work by increasing the amount of serotonin in your brain and body. Serotonin is a neurotransmitter that’s involved in regulating certain aspects of your moods, including feelings of depression and anxiety.
SSRIs can cause adverse effects, including sexual side effects. If you’re prescribed this type of medication to treat PMDD, your healthcare provider will talk to you about how to use it safely, as well as the steps that you can take if you experience any issues.
Other medications used to treat PMDD include:
Oral contraceptive pills (birth control pills). Birth control pills that contain the active ingredients drospirenone and ethinyl estradiol are approved by the FDA to treat PMDD symptoms.
Not all birth control pills contain these active ingredients. If you currently take the birth control pill, consider talking to your healthcare provider about switching to a pill that’s effective at treating PMDD.
Benzodiazepines. These medications can reduce the severity of anxiety, insomnia and certain other PMDD symptoms. Your healthcare provider may suggest using this type of medication in the short term to provide relief from your symptoms.
Over-the-counter pain medications. Over-the-counter pain relievers, such as aspirin and ibuprofen, may help with physical symptoms of PMDD, such as menstrual cramps, joint pain and headaches.
Diuretics. If you gain weight before and during your period due to water retention, your healthcare provider may prescribe a diuretic. This type of medication relieves bloating by removing salt (sodium) and water from your body.
If you’re prescribed medication to treat PMDD, make sure to follow any instructions provided by your healthcare provider. Talk to your healthcare provider before stopping treatment or making any changes to your use of medication.
Some forms of psychotherapy, such as cognitive-behavioral therapy (CBT), may make it easier for you to cope with the symptoms of premenstrual dysphoric disorder.
CBT involves identifying thought patterns that may be harmful or inaccurate, then learning how to change the way you think and behave. You may need to take part in several CBT sessions over the course of a few weeks with mental health online.
We offer online therapy, allowing you to connect with a professional counselor from home and take part in therapy without having to make a trip to your therapist’s office.
Many PMDD symptoms improve with changes to your lifestyle and the development of healthier habits. In fact, your healthcare provider may suggest making changes to your lifestyle as a good first step towards treating PMDD.
Try the following habits to reduce the severity of your premenstrual symptoms:
Eat a healthy, balanced diet. Try to eat a balanced diet that’s rich in fresh vegetables, fruits and whole grains. Limit your intake of sugary foods, salty foods, coffee and other drinks that contain caffeine.
Avoid drinking alcohol before your period. Some research suggests that alcohol is associated with an increased risk of PMS symptoms. Try to limit your consumption of alcohol (or avoid it completely) if you’re affected by PMDD.
Stay physically active. Taking part in regular exercise may help to reduce the severity of PMDD symptoms. Try to get at least 150 minutes of aerobic exercise per week, as well as two or more muscle-strengthening workouts.
Practice healthy sleeping habits. Make sure to get at least seven hours of sleep each night, or more if you’re below the age of eighteen. Using a natural sleep aid may help you to fall asleep if you’re prone to insomnia due to PMDD.
Use stress management techniques. Relaxation techniques such as mindfulness may reduce the severity of major depression, anxiety and stress. Try setting aside five to 10 minutes a day to spend on meditation and other stress management techniques.
Spend time on activities you enjoy. Another great way to de-stress and deal with the symptoms of PMDD is to spend time on things you love. Try to set aside time for your hobbies, passions and other activities whenever you feel stressed or irritable.
Currently, there’s not enough high-quality scientific evidence to suggest that herbal supplements or home remedies are effective options for treating premenstrual dysphoric disorder.
Our list of techniques for calming anxiety goes into more detail about methods that you can use to deal with some PMDD symptoms.
Premenstrual dysphoric disorder is a common problem that can have a serious impact on your health, well-being and quality of life. The good news is that it can usually be treated with simple lifestyle changes, psychotherapy and, if necessary, medication.
If you’re concerned that you might have PMDD, you can connect with a mental health provider from your home who will help you get anxiety treatment online if they determine that's the right path for you. If appropriate, you may receive prescription medication to treat your symptoms and make dealing with PMDD easier.
You can also learn more about dealing with stress, anxiety and the emotional aspects of PMDD using our free online mental health resources.
Dr. Jill Johnson is a board-certified Family Nurse Practitioner and board-certified in Aesthetic Medicine. She has clinical and leadership experience in emergency services, Family Practice, and Aesthetics.
Jill graduated with honors from Frontier Nursing University School of Midwifery and Family Practice, where she received a Master of Science in Nursing with a specialty in Family Nursing. She completed her doctoral degree at Case Western Reserve University.
Jill is a national speaker on various topics involving critical care, emergency and air medical topics. She has authored and reviewed for numerous publications. You can find Jill on Linkedin for more information.
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